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The case for Internet First

Why health and care services should be accessible over the public internet, and supporting government and NHS policy around Internet First.

Why digital services should be made available over the public internet

The public internet provides users with open access to web-based services that is not restricted by their location or their network connection. The benefits of publishing digital services on the internet include:

  • easier access to digital health and social care services, including remote working
  • it makes it easier for different digital services to work together
  • increased innovation by improving accessibility to other digital service providers
  • simpler connections for health and care organisations
  • new NHS and social care centres, such as field hospitals, can be set up more quickly

Users will still need to register and use a password so Internet First options are still secure.

Our Internet First policy

NHS Digital's Internet First policy

Our policy is fully aligned to the Secretary of State’s architecture principles and to the NHS Long Term Plan objectives to increase productivity of NHS staff and deliver digitally enabled care.

It sets the principle that all new externally accessible digital services provided by NHS Digital should be internet facing by default, and for existing digital services to be updated as soon as possible.

Why Internet First is important

Adopting the Internet First policy will help us to increase:

  • the amount of technologies and digital services that will work for us and for those we care for 
  • the number of developers and software engineers that can help us transform health and care and meet the needs of our users, by making it easier to build software and digital services for health and care
  • the amount of distributed data we can handle

Benefits to health and care

Reducing the reliance upon private networks

Reducing the reliance upon private networks means that this will:

  • help to reduce the volume of private networks required across the system and could potentially reduce costs and the carbon footprint of NHS data centre use
  • help to reduce other overhead costs in the NHS and social care by increasing access to digital services that would have otherwise required staff to use specific computers at specific locations.

Reducing the barriers to entry

Reducing barriers to entry opens the market for suppliers which will lead to: 

  • a more competitive and innovative marketplace

  • improved interoperability between digital services. 

Promoting off the shelf technologies

Commodity, off the shelf hardware and code mean less reliance on bespoke systems and rare skills to help us transform health and care to: 

  • maximise the number of developers and software engineers available 
  • build and implement software and digital services quicker

Government system wide direction

Providing clear direction across health and social care means that:

  • Internet First will bring to life the government’s vision “The future of healthcare: our vision for digital, data and technology in health and care”
  • services operating across the NHS and Social Care being available over the internet will help to build government wide consistency in digital services accessibility and architectures.

Reduction in lead time

A reduction in digital services implementation lead-times to market and networking overheads / operating costs.

Flexibility for the future 

Providing digital services over the internet optimises how we use 5G mobile networks, the Internet of Things and new technology.

Ubiquitous access 

By providing access to digital services, to all that need them, wherever they need them:

  • many more people (public and staff) can use digital health and social care services at time and place that they choose 
  • patient and citizens have a better experience with more personal control over the services they use 
  • much wider inclusion so greater equity in who can use digital services 
  • greater service efficiency to support nomad working away from a fixed base
  • users can use any device to access digital services

Background to the Internet First policy

Internet First is driven by government policies to improve Digital Service effectiveness and efficiency from the use of both internet and public cloud.  

The Digital Efficiency report 2012 anticipated process efficiencies in government departments (£1.7 – 1.8Bn / year in central government, £2.9Bn NHS). 

Non-monetised benefits such as public empowerment and employability benefits were outlined in the Government Digital Strategy.  

This was taken up at a departmental level by the Department of Health and Social Care. A Digital Health and Care system: Digital First in Primary Care proposed internet access to enable a channel shift to things like self-management and online consultations.  

A letter from John Manzoni, Chief Executive of the Civil Service and Cabinet Office Permanent Secretary, on 16 December 2016 advised: “NHS Digital, with the programme should develop successor plans to move the HSCN architecture and legacy applications progressively to a wholly internet based solution (subject to a cost benefits analysis of doing so).” 

The Government Transformation Strategy 2017, “Extended the digital agenda from the citizen to maximising the benefit of collaboration and flexibility across departments and government bodies.”  

The Government Digital Services Technology Leaders Network reviewed the positioning of centralised private networks in January 2017 and confirmed that, for the vast majority of public services, the internet is OK. They also said that new services should be made available on the internet. 

In October 2018 the Secretary of State’s (SoS) paper ‘The future of healthcare: our vision for digital, data and technology in health and care’, demanded a ‘radical new approach’. He later stated that the NHS should come off ‘expensive private networks’ and that digital services should be accessible over the internet by March 2021. 

Further information and resources

Last edited: 14 August 2020 3:42 pm